Active NPI
Jerry P Rogers, MD
- Family Medicine Physician
- Moorhead, MN
National Provider Identifier
1457381980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 25477
- Practice address
- 801 Belsly Blvd
Moorhead, MN 56560-5055 - Phone
- (701) 364-6800
- Fax
- (701) 364-6828
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 25477 | MN | Primary |
| Family Medicine Physician | 207Q00000X | 4728 | ND |
Addresses
Primary practice location
801 Belsly Blvd
Moorhead, MN 56560-5055
Mailing address
PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300
Other identifiers 18
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14614 | Medicaid | MN | |
| 28527RO | Other | ND | MNBS # |
| 6439 | Other | MN | NDBS # |
| 664582 | Other | MN | AMERICA'S PPO/ARAZ # |
| 0106001 | Other | MN | MEDICA # |
| 1739 | Other | ND | NDBS # |
| DA9011015630 | Other | MN | PREFERRED ONE # |
| 080039937 | Other | MN | RAILROAD |
| 1739 | Other | ND | ND MEDICARE # |
| MN100035 | Other | MN | LHS # |
| 122946 | Other | MN | UCARE # |
| 0108164 | Other | ND | MEDICA # |
| HP19577 | Other | MN | HEALTHPARTNERS # |
| 15959 | Other | MN | SIOUX VALLEY # |
| 0106002 | Other | ND | MEDICA # |
| 27362RO | Other | NC | MNBS # |
| 83D94RO | Other | MN | MNBS # |
| 944307000 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25477 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Mary's Regional Health Center | Past | Accepting new patients | |
| St Marys EMS | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Essentia Health St. Mary's-Frazee Clinic
- Rural Health Clinic/Center
- Frazee, MN
- NPI 1902364482
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319155200000",
"number": "1457381980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6001",
"city": "FARGO",
"state": "ND",
"postal_code": "581086001",
"telephone_number": "701-364-3300",
"fax_number": "701-364-8906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 BELSLY BLVD",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565605055",
"telephone_number": "701-364-6800",
"fax_number": "701-364-6828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROGERS",
"first_name": "JERRY",
"middle_name": "P",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2011-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "25477",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ND",
"license": "4728",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "14614",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "28527RO",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "6439",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO/ARAZ #",
"identifier": "664582",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA #",
"identifier": "0106001",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "1739",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE #",
"identifier": "DA9011015630",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "080039937",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ND MEDICARE #",
"identifier": "1739",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LHS #",
"identifier": "MN100035",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE #",
"identifier": "122946",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA #",
"identifier": "0108164",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS #",
"identifier": "HP19577",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIOUX VALLEY #",
"identifier": "15959",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA #",
"identifier": "0106002",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "27362RO",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "83D94RO",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "944307000",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.